Annexure - 1 BANK NOTE PAPER MILL INDIA PRIVATE LIMITED (A Joint venture of SPMCIL – A Govt. of India Enterprise and BRBNMPL – A Subsidiary of Reserve Bank of India) CIN:U21090KA2010PTCO55475 Corporate Office, Bangalore 560 029 Bangalore 560 029Corporate Office, Bangalore 560 029 Affix recent Passport size photograph here and sign across 01. Name of the Post Applied for 02. Name (in BLOCK LETTERS as appearing in SSLC / SSC / Matriculation / 10th Standard) 03. Father’s Name 04. Husband’s Name 05. Address for Communication : : : : : Pin: Email: Mobile No.: 06. Date of Birth (As per School Leaving Certificate –SSLC / SSC / Matriculation / 10th Standard) : : 07. Age as on 31.03.2015 08. Place & State of Domicile 09. Nationality : 10. Gender : Male/Female 11. Marital Status : Married/Single 12. : a) Whether you belong to SC / ST : / OBC category? b) If yes, write name of the : category Yes / No SC / ST / OBC Caste & Community 1-4 13. 14. 15. 16. Are you a serving Employee of SPMCIL /BRBNMPL/BNPMIPL? a) If yes, please indicate Date of appointment, Emp. No. and the Post held and name of the Organization and present place of posting : Yes / No : Date of Appointment: Emp. / Staff No. : Name of the post held: Name of the Organisation: Present place of posting: b) Period of service in the parent organisation as on 31.03.2015 Are you a PWD? If yes, Type of Disability Percentage of Disability For serving personnel Do you have the prescribed minimum years of commisioned service in Defence/Paramilitary/Central Police Organisations? If yes, Date of Enrolment (Note: Form of certificate given in annexure 1A to be enclosed) Are you an Ex-Serviceman? If yes, Period of Service as an Ex-Serviceman & Rank (Copy of discharge certificate to be enclosed) (Note: Undertaking given in annexure 1B to be enclosed) : ………… Yrs……… Months……..Days : : : : Yes / No : Yes / No Yes / No : 17. Educational Qualifications (as on 31.03.2015 ) Name of the University/Board Examination passed with Division / Class / Grade Main Subjects/ Specialisation Year of Passing Percentage of marks in aggregate of all semesters to be shown (up to 2 decimals)@ Note: Please attach separate sheet, if required. @***Total marks scored in aggregate of all semesters divided by ****Full marks in aggregate of all semesters (***/****x100=% of marks) 2-4 18. Please mention Additional Professional Qualification(s)/Training(s) Attented/Special Achivement(s) in work/profession/ field /Tests if any, (Enclose a documentry evidence) Sl. No Particulars Duration/Time period Remarks Note: Please attach separate sheet, if required. 19. Work Experience (gained as on 31.03.2015) Name of the Office / Organization and category of Industry Position Held Nature of Job / with Pay Work scale and present Basic Pay and Grade Pay/CTC Period of Employment From To Nature of Industry & Annual Turnover (in Rupees Crores) Note: Please attach separate sheet, if required. 20. Particulars of Banker’s Cheque / Demand Draft: Name of the issuing Bank Date of Issue Banker’s Cheque / Demand Draft No. Amount (in Rupees) 3-4 DECLARATION I hereby declare that all statements made by me in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect or suppressed or I do not satisfy the eligibility criteria, my candidature / appointment, at any stage, is liable to be cancelled / terminated. I am willing to service anywhere in India. I hereby agree that any legal proceedings in respect of any matter or claim or dispute arising out of this application and / or out of the said advertisement can be instituted by me only in courts / tribunal / forums at Bangalore. I undertake to abide by all the terms and conditions mentioned in the Advertisement No. 04/2014-15 issued by the Company and Rules and Regulations as may be framed by the Company. Place : (Signature of applicant) Date : Enclosures: 4-4